UNIVERSITY HEIGHTS, Ohio — University Heights Fire Chief Robert Perko is calling on the City Council to pass legislation regulating and licensing any non-911 emergency response service operating within the city, Cleveland.com reports.
Perko’s push for oversight follows concerns raised after the volunteer emergency response group Hatzalah Cleveland began providing services in the Heights, Beachwood and South Euclid earlier this year. City officials say some residents have started calling Hatzalah before contacting 911, a practice they warn could jeopardize patient outcomes.
Brennan detailed an incident on April 28 in which a resident’s family called Hatzalah first. According to Brennan, more than 2 hours passed before 911 was called and University Heights Fire Department (UHFD) paramedics arrived. The patient, who was suffering from extremely low blood pressure, was later placed in hospice care and has since died.
Perko, in his report to the council on June 16, acknowledged the patient might still have died even if 911 had been called first, but added that “perhaps there may have been a better outcome.”
| More: From 73 to 33 minutes: How Sacramento reinvented patient offload times
City leaders from Cleveland Heights, Shaker Heights, South Euclid and University Heights held a joint meeting in May to address concerns about non-911 emergency response providers. Brennan said Hatzalah Cleveland did not respond to requests to participate in either the May or a previous April meeting, and “had not been responding to leaders of the cities it serves.”
In his report, Perko said, “After the region’s safety directors raised concerns, Hatzalah’s former medical director resigned, leaving us uncertain who — if anyone locally — supervises their clinical practices now.”
Perko emphasized that his concerns are not personal or directed at the concept of volunteerism.
“Let me be clear,” he said. “Our concerns about the volunteer EMS model are not about ego, turf or any lack of appreciation for volunteerism. We fully acknowledge and respect the cultural and community values that organizations like Hatzalah provide. Many volunteers are driven by admirable motives — they see a neighbor in need and want to help. We recognize their dedication and thank those volunteers for their willingness to serve. Quick basic first aid from a Good Samaritan can absolutely save lives in the critical minutes before professionals arrive, and we welcome volunteer support that genuinely complements our work.”
He also noted the importance of cultural sensitivity, saying, “We also understand that Hatzalah exists in part to serve the unique needs of the local Jewish community, providing language, religious or comfort-level accommodations. Cultural sensitivity and trust are important, and we strive to serve every community in University Heights with understanding and respect.”
Perko also pointed to incidents that highlighted communication gaps. In one case, he said, after Hatzalah volunteers responded to a resident who was feeling ill, 911 was not called for 20 minutes. When paramedics arrived, “no formal patient handoff from volunteers to professional EMS providers was conducted,” Perko said, and crews were not informed that a second ill person was also in the house.
“Hatzalah then notified their call takers to contact 911 for a second patient,” Perko said. “Many minutes later, our dispatch contacted UHFD to respond to a second patient. When the UHFD members on scene heard this on the radio, their inclination was to cancel the request because they had no awareness of it being made, let alone that a second patient existed.”
Perko underscored the training difference between paramedics and volunteers.
“To become a paramedic requires over 1,000 hours of rigorous training and clinical experience — often 1-2 years of study — whereas a Basic EMT certification involves roughly 150 hours. In practice, this means paramedics can provide Advanced Life Support (ALS). They are qualified to perform critical interventions like airway intubations, IV therapy, heart monitoring and administering dozens of emergency medications that basic EMT volunteers are neither trained nor authorized to perform,” he said.
“Our firefighter–paramedics operate under the license and regional protocols of a medical director and adhere to strict clinical standards. When you call 911 in University Heights, you are guaranteed a response by these highly trained professionals, ready to deliver hospital-level care in minutes. This professional standard is non-negotiable, because lives depend on it,” Perko said.
He also raised concerns about the lack of coordination and unified command when volunteer groups operate independently, saying, “When volunteer units self-dispatch without integration, our crews have arrived with ‘surprise’ responders on scene, not knowing who they are or what they’ve done.”
Perko cited the importance of established medical protocols and accountability. “Unlike our fire/EMS department, which follows established medical protocols under a physician medical director, the volunteer service’s medical oversight has been opaque and inconsistent,” he said. “Operating without unified medical oversight or standardized protocols is a risk to patient safety and a legal liability for everyone involved. These issues must be resolved through formal policies.”
“In summary, the current self-promoted parallel operation of a volunteer EMS service in our city, Hatzalah Cleveland — without integration — poses real risks,” Perko said. “We have observed delays in care, duplication of effort, miscommunications and ambiguity in command. These gaps are not just theoretical; they have happened and can have serious consequences. My duty as fire chief is to identify and close these gaps before lives are put in jeopardy again.”
